Int. J. Morphol.,
31(2):578-583, 2013.
A Study of the Anatomical Variations in the Position of
the Greater Palatine Foramen in Adult Human Skulls and
its Clinical Significance
Variaciones Anatómicas en la Posición del Foramen Palatino Mayor
en Cráneos Humanos Adultos y su Significación Clínica
Mitesh R. Dave*; Vaishali Kiran Yagain** & Samir Anadkat***
DAVE, M. R.; YAGAIN, V. K. & ANADKAT, S. A study of the anatomical variations in the position of the greater palatine foramen in
adult human skulls and its clinical significance. Int. J. Morphol., 31(2):578-583, 2013.
SUMMARY: Pain is a common distressing symptom in dental practice. Depending upon the cases, different techniques are used
to relieve pain. One of these is peripheral trigeminal nerve block. Peripheral trigeminal nerve block anaesthesia has proved to be an
effective and convenient way to anaesthetise large regions of oral and maxillofacial complex. This block can be intraoral or extra oral.
The intraoral route is through the greater palatine foramen in which the dental surgeons enter into the pterygopalatine fossa, where the
maxillary nerve is situated. The morphological variations in the position of greater palatine foramen may be of clinical importance in the
administration of local anaesthesia and in palatal surgery. In the present study, the distance of greater palatine foramen from the median
palatine suture, and from the posterior border of hard palate have been noted, and the position of greater palatine foramen relative to the
maxillary molars, as well as the direction of the foramen have been examined.
KEY WORDS: Greater palatine foramen; Peripheral trigeminal nerve block; Pterygopalatine fossa; Maxillary molars.
INTRODUCTION
The bony palate on the base of the skull is formed by
the alveolar arch and the hard palate. Alveolar arch bears
the sockets for the roots of the upper (maxillary) teeth. Medial
to the third molar tooth on either side is the greater palatine
foramen, between the horizontal plate of palatine bone and
the palatine process of maxilla. Further back are small
multiple lesser palatine foramina in the pyramidal process
of the palatine bone. Through the corresponding palatine
foramina pass the greater and lesser palatine nerves and
vessels (Sinnatamby, 1999). The greater palatine nerve is a
branch of maxillary nerve, which is the second division of
trigeminal nerve. It starts in the middle of the trigeminal
ganglion and leaves the skull through foramen rotundum.
Then it enters the pterygopalatine fossa. In this fossa it gives
a number of branches and itself continues as infraorbital
nerve. The greater palatine artery is a branch of third part of
the maxillary artery in the pterygopalatine fossa. It
accompanies the greater palatine nerve in the greater palatine
canal. Here it gives two or three lesser palatine arteries, which
*
transmit through the lesser palatine foramina. Greater
palatine artery emerges through the greater palatine foramen on the hard palate with the greater palatine nerve. Then
it runs forwards in a groove to the incisive canal and
anastomoses with a branch of sphenopalatine artery. The
greater palatine nerve innervates the gums, mucous
membrane and palatine glands of the roof of the mouth.
MATERIAL AND METHOD
The present study was conducted with the aim to
ascertain the position of the greater palatine foramen in
relation with various landmarks in male and female skulls.
The study material comprised of 100 dry, sexed, adult human
skulls from sources in the various Medical Colleges of
Gujarat, India. Out of 100 skulls, 60 were males, 39 were
females, and 1 unknown sex.
Assistant Professor of Anatomy, GMERS Medical College, Valsad, Gujarat, India.
Assistant Professor, Department of Anatomy, Medical University of the Americas, Nevis, West Indies.
***
Professor, Department of Anatomy, Medical University of the Americas, Nevis, West Indies.
**
578
DAVE, M. R.; YAGAIN, V. K. & ANADKAT, S. A study of the anatomical variations in the position of the greater palatine foramen in adult human skulls and its clinical significance.
Int. J. Morphol., 31(2):578-583, 2013.
Fig. 1. Illustrates the measurement of distance from greater palatine
foramen to Median palatine suture. (GPF= Greater palatine foramen; MPS= Median palatine suture).
Fig. 2. Illustrates the measurement of distance from greater palatine
foramen to Posterior palatal margin. GPF= Greater palatine foramen; PPB= Posterior palatal margin.
Sex of the skulls was determined by the following
criteria:
foramen on a line represented by a lateral extension of the
posterior margin of hard palate. This distance was then
recorded to the nearest 0.1 mm.
Male skull: larger, heavier, more prominent muscular
markings especially superciliary arches, external occipital
protuberance, nuchal lines, and muscular ridges on mastoid
process.
Female skull: relatively smaller, lighter, less prominent muscular markings especially rounded superciliary arches,
blunted and rounded external occipital protuberance, less
marked nuchal lines, smoother mastoid process.
Keeping in view the aims of the study mentioned
above, the following observations were recorded in
millimetres, using a pair of Vernier callipers.
Distance between greater palatine foramen and median palatine suture (Fig. 1): the fixed end of calliper compass
was placed in the middle of the anterior margin of the foramen, and movable point was placed on the median palatine
suture along a line extending medially from the middle of
the anterior margin of the foramen and perpendicular to
midsagittal plane. The distance between the arm points was
then measured to the nearest 0.1 mm.
Distance between greater palatine foramen to the posterior palatal margin (Fig. 2): the fixed end of calliper
compass was placed in the middle of the medial margin of
the foramen, and movable point was placed posterior to the
In order to ascertain the location of the greater palatine
foramen in relation to maxillary molars (Figs. 3 and 4): a
perpendicular line was drawn from the center of the foramen to midsagittal plane, and was extended towards molars.
The point at which this line intersected, the maxillary molar
was noted. To find out whether the opening of the foramen
is horizontal (anterior) or vertical (inferior), mental probe
was used.
For distance of longitudinal palatal grooves, the fixed
end of calliper compass was placed in the anterior margin of
the greater palatine foramen and the movable point was
placed at the anterior distinct end of the groove and distance
measured to the nearest 0.1 mm. Also, the tooth level where
the groove ended was noted (Fig. 3).
Observations thus made were compiled and tabulated.
The following indices were calculated:
Mean value and Standard deviation for the distances
of the greater palatine foramen from the median palatine
suture, in male and female skulls, were calculated.
Mean value and Standard deviation for the distances
of the greater palatine foramen from the posterior margin of
hard palate, in male and female skulls, were calculated.
579
DAVE, M. R.; YAGAIN, V. K. & ANADKAT, S. A study of the anatomical variations in the position of the greater palatine foramen in adult human skulls and its clinical significance.
Int. J. Morphol., 31(2):578-583, 2013.
Fig. 3. Illustrates the position of greater palatine foramen medial
to the maxillary third molar tooth (lower arrow), and Longitudinal
groove (upper arrow). GPF= Greater palatine foramen; M3=
Maxillary third molar tooth.
Further, to test the significance of the differences of
observations in different subgroups of study sample in n (1)
and (2), Z test was used. Following are the confidence limits
for Z test: If calculated Z value<1.96; P>0.05 = Not significant;
If calculated Z value>=1.96; P=<0.05 = Significant; and If
calculated Z value>=2.56; P=<0.01 = Highly significant.
RESULTS
Table I shows that there is no significant difference
in the distances between right and left sides of the same
type of skulls. But the distances are significant for right sides
of the two types of skulls.
Table II shows that there is no significant difference
in the distances between right and left sides of the same
type of skulls. Further, the differences in distances in the
two types of skulls were also not significant.
Fig. 4. Illustrates the position of greater palatine foramen behind the
maxillary third molar tooth. GPF= Greater palatine foramen; LPF=
Lesser palatine foramen; M3= Maxillary third molar tooth; M2=
Maxillary second molar tooth; M1= Maxillary first molar tooth.
Table III shows the variations in the position of greater
palatine foramen relative to the maxillary molars.
In Table IV were evaluated the direction of opening
of greater palatine foramen onto the palate in males and
females. For longitudinal grooves, mean length of the
groove from the anterior margin of greater palatine foramen to its distinct end is 45.08 mm (Fig 3). 5.5% of the
grooves were divided. The frequency (%) of the extent
of the groove in relation to the tooth level where the
groove ended distinctly: a) 1st maxillary molar = 18.0 b)
2nd maxillary premolar = 24.0, c) Between 2nd maxillary
premolar and 1st premolar = 0.5, d) 1st maxillary premolar
= 27.5, e) Between 1st maxillary premolar and canine =
7.5, f) Between maxillary canine and lateral incisor = 2.5,
g) 2nd maxillary molar = 17.5 and h) 3rd maxillary molar = 2.5
Table I. Distance (mm) of greater palatine foramen from median palatine suture in
males and females.
Value
Male skulls
Female skulls
Unknown
Right
Left
Right
Left
Right
Left
60
60
39
39
1
1
Mean distance (mm)
16.7
16.6
16.2
16.4
17.0
16.5
SD
0.112
0.109
0.116
0.110
----
----
n of observations
Difference in distances a) Right and Left sides of male skulls: Not significant (P=0.62), b) Right
and Left sides of female skulls: Not significant (P=0.45), c) Right sides of male and female
skulls: Significant (P=0.038) and d) Left sides of male and female skulls: Not significant (P=0.37).
580
DAVE, M. R.; YAGAIN, V. K. & ANADKAT, S. A study of the anatomical variations in the position of the greater palatine foramen in adult human skulls and its clinical significance.
Int. J. Morphol., 31(2):578-583, 2013.
Table II. Distance (mm) of greater palatine foramen from posterior margin of hard palate in
males and females.
Value
Male skulls
Female skulls
Unknown
Right
Left
Right
Left
Right
Left
n of observa tions
60
60
39
39
1
1
Mean distance (mm)
6.9
6.9
6.8
7.0
6.5
6.0
0.133
0.119
0.116
0.128
----
----
SD
Statistical interpretation - Difference in distances: 1. Right and Left sides of male skulls: Not significant
(P=0.66), 2. Right and Left sides of female skulls: Not significant (P=0.47), 3. Right sides of male and
female skulls: Not significant (P=0.71) and 4. Left sides of male and female skulls: Not significant (P=0.69).
Table III. Variations in the position of greater palatine foramen relative to the maxillary molars.
Teeth
Male skulls (60)
Right GPF
n
%
Female skulls (39)
Unknown (1)
Left GPF
Right GPF
Left GPF
n
%
n
n
%
Right
Left
%
n
n
Total
n
%
M4
6
10
2
3.3
6
15.4
2
5.1
---
---
16
8.0
M3
51
85
57
95
29
74.4
36
92.3
1
1
175
87.5
M*
3
5
1
1.7
3
7.6
---
---
---
---
7
3.5
M2
---
---
---
---
1
2.6
1
2.6
---
---
2
1.0
Abbreviations: GPF=Greater palatine foramen; M4=Behind third molar; M3=Medial to third molar; M*= Between second and third
molar; M2=Medial to second molar.
Table IV. Direction of opening of greater palatine foramen
onto the palate in males and females.
Direction
Right
Left
n
%
n
%
4
4
4
4
96
96
96
96
the lateral margin of hard palate behind the palatomaxillary
suture, while Sicher & Dubrul (1980) had reported it close
to the posterior margin of the hard palate.
Locating the greater palatine foramen is important
clinically when a trigeminal second division block is needed
or when posterior palatal anaesthesia is desired. Significant
variations in the location of the foramen were seen in this
study, and the knowledge of these variations is a must for
effective local anaesthesia.
According to Moore (1980) it was medial to the third
molar tooth. Robert & Sowray (1979) had reported it medial
to the second and third molars, while Mercuri (1979) had
reported it distal to the second molar. Westmoreland &
Blanton (1982) had cited it commonly opposite the third
molar (50.7%). Next common site was between second and
third molars (33.7%). In 9.7% it was opposite second molar, and in 6% it was distal to third molar. According to
Khatri et al. (1986), the foramen was located opposite the
third molar in 56%, behind third molar in 16%, opposite
second molar in 14%, and between second and third molars
in 14%. In the present study, the foramen was medial to
third molar in 87.5% (Fig 3); between second and third
molars in 3.5%; behind third molar in 8% (Fig 4); and
medial to second molar in 1% skulls studied.
Different authors describe the location of the foramen differently. According to Goss (1973), Hassanali &
Mwaniki (1984) and Snell (1981), the foramen was located
in the posterolateral angle of the hard palate. Whereas Frazer
(1965), Romanes (1981), Slavkin et al. (1966), and
Macintosh & Ostlere (1955) had cited it opposite the last
maxillary molar tooth. Bannister (1989) had reported it near
Distance from Greater palatine foramen to median
palatine suture and posterior margin of hard palate:
According to Westmoreland & Blanton, the mean distance
measured from the foramen to median palatine suture was
1.5 cm. Khatri et al., reported that the foramen lies 1.57cm
on the right side and 1.61 cm on the left side. In the present
study, it was 1.67 cm on the right side and 1.66 cm on the
Horizontal
Vertica l
DISCUSSION
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DAVE, M. R.; YAGAIN, V. K. & ANADKAT, S. A study of the anatomical variations in the position of the greater palatine foramen in adult human skulls and its clinical significance.
Int. J. Morphol., 31(2):578-583, 2013.
left side in the male skulls. ‘Z’ test was applied and the
difference was found to be insignificant.
According Westmoreland & Blanton, the mean
distance measured from the foramen to posterior palatal
margin was 0.19 cm, and according to Khatri et al., the
foramen was 0.54 cm from posterior palatal margin. In the
present study, the foramen was 0.69 cm on the right side
and 0.69 cm on the left side in the male skulls. ‘Z’ test was
applied and the difference in the distance was found to be
insignificant. The distance measured in female skulls from
foramen to median palatine suture was 1.62 cm on right
side and 1.64 cm on left side. ‘Z’ test was applied and the
difference in distance was found to be insignificant. The
mean distance measured from the foramen to posterior
palatal margin was 0.68 cm and 0.70 cm on the right and
left sides of female skulls respectively. ‘Z’ test was applied
and the difference in the distance was found to be
insignificant. ‘Z’ test was also applied for the distance from
the right foramen to median palatine suture in the male
and female skulls, and the left foramen to median palatine
suture in the male and female skulls. The difference in
distance was found to be significant on the right side only.
‘Z’ test was also applied for the distance from the foramen
to posterior palatal margin in the male and female skulls
on the right and left sides, and the difference in distance
was found to be insignificant.
Direction of Greater palatine foramen: Hassanali
& Mwaniki described that in 74% cases the foramen
opened in oblique direction anteromedially, and in 26% it
opened perpendicularly downward.
According to Westmoreland & Blanton, the
direction of foramen was inferior or vertical in 82%, and
anterior or horizontal in 18%. Khatri et al., had reported
the direction of the foramen as downward in 72% cases,
and downward & forward in 28% of skulls. In the present
study, the foramen was found to be directed horizontally
(4% on both right and left sides), and vertically (96% on
both right and left sides).
Longitudinal palatal grooves: These were common
feature found bilaterally in all the palates (Fig. 3). The
grooves were extensive; 5.5% showing divisions; 86.5%
had crests along its length. Bennett (1978) states that it
will be advantageous to insert the needle and deposit the
solution so that the anterior palatine nerve will be
anaesthetised anteriorly to the foramen. Clinically, the
presence of crests and bridges along the grooves and
particularly at the opening of the foramen may present
problems in the administration of local anaesthesia.
CONCLUSION
In the present study, the greater palatine foramen was
found to be against the maxillary third molar in most of the
skulls (87.5%). Locating this foramen, and keeping in mind
the distance from the foramen to median palatine suture and
posterior palatal margin, is important clinically when a
trigeminal second division block is needed or when posterior palatal anaesthesia is desired.
ACKNOWLEDGEMENTS
Our sincere thanks to the faculty members of our
university who helped and supported during the writing of
this manuscript.
DAVE, M. R.; YAGAIN, V. K. & ANADKAT, S. Variaciones anatómicas en la posición del foramen palatino mayor en cráneos
humanos adultos y su significación clínica. Int. J. Morphol., 31(2):578-583, 2013.
RESUMEN: El dolor es un síntoma común y preocupante en la práctica dental. Dependiendo de los casos, diferentes técnicas se
utilizan para aliviar el dolor. Una de ellas es el bloqueo periférico del nervio trigémino. Esta, ha demostrado ser una forma eficaz y
conveniente para anestesiar grandes regiones del complejo oral y maxilofacial. Este bloqueo puede ser intraoral o extraoral. La vía
intraoral es a través del foramen palatino mayor en la cual se ingresa en la fosa pterigopalatina, donde se encuentra el nervio maxilar. Las
variaciones morfológicas en la posición del foramen palatino mayor puede ser de importancia clínica en la administración de anestesia
local y en la cirugía del paladar. En el presente estudio, se examinó la distancia del foramen palatino mayor desde la sutura palatina
mediana y el margen posterior del paladar duro, y su posición relativa a los molares superiores, así como la dirección del foramen
palatino mayor.
PALABRAS CLAVE: Foramen palatino mayor; Bloqueo periférico del nervio trigémino; Fosa pterigopalatina; Molares
maxilares.
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DAVE, M. R.; YAGAIN, V. K. & ANADKAT, S. A study of the anatomical variations in the position of the greater palatine foramen in adult human skulls and its clinical significance.
Int. J. Morphol., 31(2):578-583, 2013.
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Correspondence to:
Professor of Anatomy
GMERS Medical College
Valsad
Gujarat
INDIA
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Email: miteshdave30@yahoo.com
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